Tissue coagulation method and device using inert gas

ABSTRACT

A gas-enhanced electrosurgical method and apparatus for coagulating tissue. The apparatus includes a first tube with a proximal end and a distal end. The proximal end of the first tube is configured to receive pressurized ionizable gas. The distal end of the first tube is configured to deliver ionized gas towards a treatment area. The apparatus also includes at least one electrode positioned to selectively ionize the pressurized ionizable gas before the pressurized ionizable gas exits the distal end of the first tube. The electrode is adapted to operatively couple to an electrical energy source. The apparatus also includes a second tube with proximal and distal ends. The second tube is configured to selectively evacuate the ionized gas and dislodged tissue material from the treatment area.

CROSS-REFERENCED TO RELATED APPLICATION

This application is a Continuation Application of U.S. patentapplication Ser. No. 11/370,287, now U.S. Pat. No. 7,648,503, filed onMar. 8, 2006, the entire contents of which is incorporated herein byreference in its entirety.

TECHNICAL FIELD

The present disclosure relates to gas-enhanced electrosurgical methodsand devices. More particularly, the present disclosure relates to agas-enhanced electrosurgical device and method for supplying gas to andremoving gas from a surgical site.

BACKGROUND OF RELATED ART

Over the last several decades, more and more surgeons are abandoningtraditional open methods of gaining access to vital organs and bodycavities in favor of endoscopes and endoscopic instruments that accessorgans through small puncture-like incisions. Endoscopic instruments areinserted into the patient through a cannula, or a port that has beenmade with a trocar. Typical sizes for cannulas range from about threemillimeters to about twelve millimeters. Smaller cannulas are usuallypreferred, and this presents a design challenge to instrumentmanufacturers who must find ways to make surgical instruments that fitthrough the cannulas and operate in a safe and effective manner.

Devices for arresting blood loss and coagulating tissue are well knownin the art. For example, several prior art instruments employ thermiccoagulation (heated probes) to arrest bleeding. However, due to spacelimitations, surgeons can have difficulty manipulating an instrument tocoagulate, desiccate, fulgurate and/or cut tissue. Other instrumentsdirect high frequency electric current through the tissue to stop thebleeding. Eschar adherence may also be a problem with these instruments.In both types of instruments, the depth of the coagulation is difficultto control.

Using these instruments to treat certain more sensitive tissue sites maybe impractical since the constant and/or direct emission of ionizedgas/plasma at the tissue may cause unintended results. Moreover, simplycontrolling the pressure of the gas from the source may not be effectiveor yield a desired result.

SUMMARY

The present disclosure relates to an electrosurgical apparatus andmethod for coagulating tissue. An electrosurgical apparatus includes afirst tube with a proximal end and a distal end. The proximal end isconfigured to receive pressurized ionizable gas and the distal end isconfigured to deliver ionized gas towards a treatment area. Theelectrosurgical apparatus also includes at least one electrodepositioned to selectively ionize the pressurized ionizable gas prior tothe pressurized ionizable gas exiting the distal end of the first tube.The electrode is adapted to be operatively coupled to an electricalenergy source. The electrosurgical apparatus also includes a second tubewith proximal and distal ends. The second tube is configured toselectively evacuate the ionized gas and dislodged tissue material fromthe treatment area.

In one embodiment, the first tube is concentrically disposed within thesecond tube.

In an exemplary embodiment, the distal end of the first tube extendsdistally relative to the distal end of the second tube.

The electrode may be activated with a first electrical potential and theelectrical energy source may include a remote patient pad that isenergized to a second electrical potential.

In an embodiment of the disclosure, the electrosurgical apparatus isconfigured for use in a bipolar mode wherein the first tube is activatedwith a first electrical potential and the second tube is activated witha second electrical potential.

In an exemplary embodiment, the electrosurgical apparatus includes aregulator which regulates the flow of pressurized argon through thefirst tube. The regulator is disposed between a gas supply of thepressurized argon and the proximal end of the first tube.

In another embodiment of the disclosure, the electrosurgical apparatusincludes a fluid agitator, which may be disposed within the first tube,to impart non-laminar flow characteristics to the pressurized ionizablegas. Here, the pressurized ionizable gas may be used to cool tissue.

The present disclosure also relates to an electrosurgical apparatus forcoagulating tissue that is configured to use in a bipolar mode. In thisembodiment, an electrode control mechanism that controls the currentintensity to the electrode is disclosed.

The present disclosure also relates to a method for coagulating tissue.The method includes the steps of providing an electrosurgical apparatusincluding a first tube configured to receive pressurized ionizable gasand to deliver ionized gas towards a treatment area, at least oneelectrode positioned to selectively ionize pressurized ionizable gasprior to the pressurized ionizable gas exiting the first tube, and asecond tube being configured to selectively evacuate the ionized gas anddislodged tissue material from the treatment area. The remaining stepsinclude inserting the electrosurgical apparatus into tissue; deliveringionizable gas to the first tube; ionizing pressurized ionizable gas;delivering pressurized ionized gas through the first tube towards thetreatment area; and removing pressurized ionized gas from the treatmentarea via the second tube. Additionally, a step of inserting anintroducer into the tissue is disclosed.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an electrosurgical instrument accordingto an embodiment of the present disclosure;

FIG. 2 is an enlarged, side sectional view of one embodiment of thepresent disclosure showing a first tube and a second tube inserted intotissue;

FIG. 3 is an enlarged, side sectional view of the area of detail shownin FIG. 2;

FIG. 4 is an end cross-sectional view of the first tube and the secondtube according to one embodiment of the present disclosure;

FIG. 5 is an enlarged, schematic sectional view of the first tube andthe second tube illustrating ionized gas treating a tissue surface;

FIG. 6 is an enlarged, schematic sectional view of the first tube andthe second tube illustrating a helically-shaped baffle located with thefirst tube for causing ionizable gas and/or ionized gas to exit thefirst tube with predetermined flow characteristics;

FIG. 7A is an enlarged, schematic sectional view of the first tube andthe second tube wherein the first tube includes a rotating plenum havingan aperture therein for causing ionizable gas and/or ionized gas to exitthe first tube with predetermined flow characteristics;

FIG. 7B is a cross-sectional view of the embodiment of FIG. 7A takenalong line 7B-7B;

FIG. 8A is an enlarged, schematic sectional view of the first tube andthe second tube wherein the first tube includes a pair of elongatedflaps therein for causing ionizable gas and/or ionized gas to exit thefirst tube with predetermined flow characteristics; and

FIG. 8B is a cross-sectional view of the embodiment of FIG. 8A takenalong line 8B-8B.

DETAILED DESCRIPTION

Referring to FIG. 1, a gas-enhanced tissue coagulator generallyidentified by reference numeral 10 is shown extending through a workingchannel of an endoscope 12. The coagulator 10 may be employed with avariety of suitable endoscopes, such as those manufactured by Olympus,Pentax and Fujinon. As such, only the basic operating features of theendoscope 12 that work in combination with the present disclosure needto be described herein.

Generally, the endoscope 12 includes a hand piece 26 having a proximalend 27 and a distal end 29. The proximal end 27 is mechanically coupledto a supply 19 of pressurized ionizable gas, e.g., inert gas, via hose20 and electrically coupled to an electrosurgical generator 22 by way ofcable 24 to supply electrosurgical energy, e.g., high frequencycoagulation current, to the endoscope 12. The electrosurgical generator22 may be configured to selectively control the amount ofelectrosurgical energy transmitted to an electrode during a surgicalprocedure. The supply 19 of pressurized ionizable gas may be configuredto selectively control the rate of flow of gas, which is typicallygreater than 1 liter per minute.

As shown in FIGS. 1 and 2, a long, generally flexible tubular member 13having a first tube 100 located within a second concentric tube 200 ismechanically coupled to the distal end 29 of the hand piece 26. Firsttube 100 includes a proximal end 110 and a distal end 120 and secondtube 200 includes a proximal end 210 and a distal end 220. As bestillustrated in FIG. 4, first tube 100 and second tube 200 areconcentrically oriented, such that first tube 100 is disposed withinsecond tube 200. First tube 100 and second tube 200 may includeinsulation coatings 102, 202, respectively, to electrically isolatetubes 100 and 200 from one another. Distal end 120 of the first tube 100extends distally from the distal end 220 of the second tube 200, thepurposes of which are explained in more detail below.

Turning now to FIG. 2, an enlarged, side sectional view of oneembodiment of the coagulator 10 is shown. First tube 100 and second tube200 are shown inserted into tissue, generally designated as “N.” Thefirst tube 100 is configured to deliver ionizable gas towards atreatment area “T” out of its distal end 120. The proximal end 110 ofthe first tube 100 is configured to receive ionizable gas from thesupply 19. Second tube 200 is configured to remove or evacuate gasand/or waste from the treatment area “T” through distal end 220. The gasand/or waste exits through proximal end 210 and is typically collectedin a known manner such as a suitable medical waste container or a wastecontainment system. An introducer 300 may be utilized to facilitate theinsertion of the coagulator 10 into the tissue “N”.

With continued reference to FIGS. 1 and 2, ionizable gas, e.g., argon,is supplied to the proximal end 110 of the first tube 100 by a gasconduit (not explicitly shown) located inside tubular member 13.Ionizable gas 19 may be supplied to the first tube 100 at a selectable,predetermined flow rate. The flow rate of the ionizable gas may beselectively adjustable and/or regulated via a pressure regulator 21depending upon a particular purpose or a particular surgical condition.

As mentioned above, the ionizable gas is supplied under pressure to theproximal end 110 of the first tube 100 and flows generally within thefirst tube 100 towards distal portion 120. An electrode 48 (see FIG. 5)discharges an electrosurgical current, e.g., radio frequency (RF), whichionizes the gas prior to the gas being expelled from the distal end 110of the first tube 100 towards tissue “N.” (Ionizable gas is illustratedas dashed arrows 18 in FIG. 5 and the resulting ionized gas isillustrated by the area designated as reference numeral 46.) The streamof ionized gas 46 conducts current to the tissue 50 while effectivelyscattering blood away from the treatment site allowing the tissue 50 toreadily coagulate and arrest bleeding. The ionized gas 46 along with anyvaporized material 52 is then suctioned away from the tissue (in thedirection indicated by arrows A) through distal end 220 of second tube200 via a suitable suctioning device (not explicitly shown). As bestshown in FIG. 5, the generally wide ionized gas area allows a surgeon toeffectively coagulate a wide tissue area. This is commonly referred toas a “coagulative painting.”

Electrode 48 is connected by way of an electrical conduit disposedwithin the first tube 100, which is ultimately connected to theelectrosurgical generator 22. The electrode 48 may be ring- or pin-typeand is spaced from the distal opening 110 of the first tube 100 suchthat the electrode 48 does not come into contact with the tissue “N” ortissue 50 during the surgical procedure. In one embodiment of thepresent disclosure, an electrode control mechanism 60 allows an operatorto control the current intensity to the electrode 48 during surgicalprocedures.

Ionizable gas 18 is controlled/manipulated such that it flows throughthe first tube 100 in a generally non-laminar or turbulent manner.However, various systems may be employed to cause the ionizable gas 18to flow more or less turbulently or with other predetermined flowcharacteristics through the first tube 100. The gas flow may be used tocool tissue, thus reducing thermal margins or areas of ablated tissueduring coagulation.

A fluid agitator, for example, such as a ribbon 62 (see FIG. 1), may bepositioned within the first tube 100 to cause ionizable gas 18 and/orionized gas 46 to swirl therewithin prior to the ionizable gas 18 and/orionized gas 46 exiting the distal end 110 of the first tube 100.Additionally, with reference to FIG. 6, a generally helically-shapedbaffle 64 may be positioned within the first tube 100 to cause ionizablegas 18 and/or ionized gas 46 to swirl within first tube 100 prior to thegas 18 or 46 exiting distal end 120 of first tube 100.

A rotatable plenum 66 is illustrated in FIGS. 7A and 7B, which includesat least one aperture 68 located therethrough. In this embodiment, theforce of the ionizable gas 18 and/or ionized gas 46 flowing throughaperture 68 causes the plenum 66 to rotate, which in turn causes theionizable gas 18 and/or ionized gas 46 to swirl with predetermined flowcharacteristics. It is envisioned that the user can control therotational speed of the plenum 66 by varying the pressure of ionizablegas 18 and/or ionized gas 46 flowing through first tube 100. It is alsoenvisioned that the rotational speed of the plenum 66 is controlled by aseparate mechanism that is independent of the ionizable gas 18 and/orionized gas 46, e.g., a regulator (not explicitly shown).

FIGS. 5A and 8B illustrate a flow system that includes a pair of rods 70disposed within first tube 100 for supporting a pair of elongated flaps72. Under flow conditions, flaps 72 attenuate/extend from rods 70 andflutter within the stream of ionizable gas 18 and/or ionized gas 46, Itis envisioned that the force of ionizable gas 18 and/or ionized gas 46flowing through first tube 100 causes each flap 72 to flutter, which inturn causes ionizable gas 18 and/or ionized gas 46 to move in a moreturbulent manner. It is also envisioned that the rate/frequency of theflutter is directly related to the pressure of ionizable gas 18 and/orionized gas 46 flowing through first tube 100. Any suitable number offlaps 72 can be employed to create certain flow conditions, e.g., aseries of flaps 72 can be positioned at various positions along firsttube 100 to create a more turbulent flow of ionizable gas 18 and/orionized gas 46. Moreover, the length of each flap 72 may be varied tocreate additional flow effects.

Coagulator 10 may be configured for monopolar and/or bipolar modes. Inthe monopolar mode, the first tube 100 may be the active electrode and apatient pad 17 (FIG. 5) may be the return electrode. In the monopolarmode, an arcing pattern 410 (FIG. 3) may radiate out from the distal end120 of the first tube 100. In the bipolar mode, the first tube 100 maybe the active electrode and the second tube 200 may be the returnelectrode. In the bipolar mode, the conductive path, represented bydashed lines 420, would be relatively self-contained at the distal end120 of the first tube 100 due to the proximity of the active electrodeand the return electrode. In one embodiment, monopolar and bipolar modesmay be alternated a plurality of times per second during use, whichwould enable the conductive path in monopolar mode to arc into thesurrounding tissue 50 causing desiccation and vaporization of the tissue50 in close proximity to the distal end 120 of the first tube 100. Theconductive path in bipolar mode further desiccates material that hasbeen separated from the tissue 50 as the conductive path enters thesecond tube 200.

In operation, the introducer 300 may be inserted through the body andplaced into tissue “N.” A stylet (not shown) may facilitate theinsertion of the introducer 300 into the tissue “N” by taking impedancereadings. The stylet may then be removed upon confirmation of a desiredimpedance reading. Tubular member 13 of the coagulator 10 may then beinserted into the introducer 300, providing free access to the tissue“N.” Once tubular member 13 is place in the tissue “N,” the gas flow maybe selectively initiated and the electrode 48 is thereafter selectivelyactivated. A corona electrode may be used for inducing ignition of theionizable gas 18. Ionized gas 46 flows out of the first tube 100 and issuctioned back into the second tube 200. When argon gas is used, theargon restricts the amount of tissue affected to the material that isadjacent the distal end 120 of the first tube 100. Nuclear material nearthe distal end 120 of the first tube 100 is thus vaporized and removedvia the second tube 200.

From the foregoing and with reference to the various figures, thoseskilled in the art will appreciate that not only can the coagulator 10of the present disclosure be used to arrest bleeding tissue, but thepresent disclosure can also be employed for desiccating and/or removingthe surface tissue, eradicating cysts, forming eschars on tumors orthermically marking tissue. Those skilled in the art will alsoappreciate that certain modifications can be made to the presentdisclosure without departing from the scope of the present disclosure.

For example, the coagulator 10 of the present disclosure may includearticulating qualities. In addition, tubular member 13, or at least aportion thereof, may have an arcuate shape. Moreover, the coagulator 10of the present disclosure may be used while performing liposuctionand/or for treating tumors. In such tumor-treating embodiments, a levelof coagulation may be achieved and the second tube 200 may removematerial, as opposed to coagulating the tissue and leaving it in thebody. Furthermore, certain aspects of the present disclosure may beutilized with a portable device and a portable argon supply.

There is described and illustrated herein several embodiments of agas-enhanced electrosurgical device that supplies gas to and removes gasfrom a treatment area. While particular embodiments of the disclosurehave been described, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of various embodiments. Those skilled inthe art will envision other modifications within the scope and spirit ofthe claims appended hereto.

What is claimed is:
 1. An electrosurgical apparatus for coagulatingtissue, comprising: a first tube having a proximal end and a distal end,the proximal end configured to receive pressurized ionizable gas and thedistal end configured to deliver ionized gas towards a treatment area;at least one electrode positioned to selectively ionize the pressurizedionizable gas prior to the pressurized ionizable gas exiting the distalend of the first tube, the electrode adapted to be operatively coupledto an electrical energy source; and a second tube having proximal anddistal ends, the second tube configured to selectively evacuate theionized gas and dislodged tissue material from the treatment area,wherein the distal end of the first tube extends distally beyond thedistal end of the second tube and wherein the distal end of the secondtube extends distally beyond a distal end of the at least one electrode,wherein the electrosurgical apparatus is configured for simultaneous usefor monopolar ablation and to ionize the ionizable gas while the distalend of the second tube extends distally beyond the distal end of the atleast one electrode.
 2. The electrosurgical apparatus according to claim1, wherein the first tube is concentrically disposed within the secondtube.
 3. The electrosurgical apparatus according to claim 1, furthercomprising a regulator that regulates the flow of pressurized argonthrough the first tube, the regulator disposed between a gas supply ofthe pressurized argon and the proximal end of the first tube.
 4. Theelectrosurgical apparatus according to claim 1, further comprising afluid agitator, the fluid agitator configured to impart non-laminar flowcharacteristics to the pressurized ionizable gas.
 5. The electrosurgicalapparatus according to claim 4, wherein the fluid agitator is disposedwithin the first tube.
 6. The electrosurgical apparatus according toclaim 1, wherein the pressurized ionizable gas is used to cool tissue.7. The electrosurgical apparatus according to claim 1, wherein the firsttube defines a longitudinal axis, and wherein the longitudinal positionof the at least one electrode is fixed with respect to the first tubeand the second tube.
 8. A method for coagulating tissue, the methodincluding the steps of: providing an electrosurgical apparatus, theelectrosurgical apparatus including a first tube, at least one electrodepositioned to selectively ionize pressurized ionizable gas prior to thepressurized ionizable gas exiting the first tube, and a second tube,wherein a distal end of the first tube extends distally beyond a distalend of the second tube and wherein the distal end of the second tubeextends distally beyond a distal end of the at least one electrode;inserting a portion of the electrosurgical apparatus into tissue;activating the first tube with a first electrical potential; activatinga second structure with a second electrical potential; delivering gasthrough the first tube towards the treatment area; removing gas from thetreatment area via the second tube; and simultaneously ablating tissuein a monopolar manner and ionizing the pressurized ionizable gas flowingthrough the electrosurgical apparatus while the distal end of the secondtube extends distally beyond the distal end of the at least oneelectrode.
 9. The method according to claim 8, wherein the secondstructure includes a remote patient pad.
 10. The method according toclaim 8, further including the step of inserting an introducer intotissue.
 11. The method according to claim 8, wherein the first tube isconcentrically disposed within the second tube.
 12. The method accordingto claim 8, further including the step of regulating the flow of gasthrough the first tube via a regulator.
 13. The method according toclaim 8, further including the step of imparting a non-laminar flow tothe gas via a fluid agitator.
 14. The method according to claim 13,wherein the fluid agitator is disposed within the first tube.
 15. Themethod according to claim 8, wherein the gas is used to cool tissue. 16.The method according to claim 8, wherein the gas includes argon.
 17. Themethod according to claim 8, wherein the first tube defines alongitudinal axis, and wherein the longitudinal position of the at leastone electrode is fixed with respect to the first tube and the secondtube.